Microcatheter Assistance in Intracranial Aneurysm Treatment with Woven Endobridge

Background Woven Endobridge (WEB, Microvention) is increasingly used to treat intracranial aneurysms. However, insertion of this device is not easy. If the aneurysmal axis is not parallel to the microcatheter and the aneurysmal dome, malposition or migration may occur. For the achievement of proper insertion, microcatheter have been shown to be good supporter for WEB insertion. In this study, we report two cases of WEB insertion using microcatheters. Methods A 78‐year‐old female patient presented with an unruptured intracranial aneurysm in the middle cerebral artery (MCA) bifurcation. After multiple failed attempts to insert a large WEB, a smaller WEB was inserted. Immediately after the device was detached, the axis of the device shifted, causing slight disruption of blood flow in one of the MCA branches by the lateral portion of the WEB. A microcatheter was inserted for rescue purposes, and navigation was used to rotate the WEB to move the WEB portion upward. Another microcatheter was used to push the WEB portion forward and completely reinserted into the aneurysmal sac. A 52‐year‐old female patient presented with the same aneurysm location. A microcatheter for WEB was inserted, but the location was on one side of the aneurysmal neck. Another microcatheter was used for rescue or assistive purposes, and the position of the microcatheter for WEB was also adjusted. Although the lateral end of the WEB slightly disrupted blood flow in the MCA, another microcatheter protected the MCA branch and the aneurysmal neck, successfully completing WEB insertion. Results Another microcatheter played multiple roles in the placement of the WEB. First, it protected the aneurysmal neck, second, it repositioned the microcatheter for WEB, and third, it limited the lateral part of the WEB with the microcatheter. Conclusions Microcatheter assisted technique may be good option for WEB deployment.